Group A streptococcal pharyngitis can present with a characteristic “strawberry tongue,” with hypertrophic red papillae on a thick white coat, tonsillar hyperemia, hypertrophy, and exudate, and palatal petechiae ( Fig 52.2 ) If an erythematous, papular “sandpaper” rash is present, most commonly on the trunk, the condition is termed scarlet fever Ludwig angina is a rapidly progressive cellulitis of the sublingual and submandibular space, resulting in skin erythema, pitting edema, trismus, and high fever, with the potential for airway compromise if inadequately treated Treatment includes surgical drainage and broad spectrum antibiotics Koplik spots are pinpoint white macules on markedly erythematous mucous membranes, occurring with cough, coryza, conjunctivitis, and fever during the prodrome of measles They generally resolve before the characteristic rash occurs Varicella lesions occurring in the mouth are self-limited, painful vesicles on an erythematous base, sometimes found unroofed Pain may lead to reluctance to swallow